Organization Name: | CENTER FOR ADVANCED DENTISTRY |
NPI Number: | 1003188046 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JONATHAN ANDREW BERNSTEIN (PRESIDENT) |
Mailing Address: | 220 Main St Auburn |
State: | ME US |
Postal Code: | 042105723 |
Phone Number: | 7167847355 |
Fax Number: | |
NPI Enumeration Date: | 02/07/2012 |
NPI Last Update Date: | 02/07/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | DEN4200 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |